Self-Directed IRA Application Packet€¦ · Self-Directed IRA Application Packet SEP Application Packet Office 100 Concourse Parkway P Suite 170 Birmingham, AL 35236 Birmingham,

Self-Directed IRAApplication Packet

SEP Application Packet

Office100 Concourse Parkway Suite 170 Birmingham, AL 35244

P: (205) 985-0860

Mailing P.O. Box 360750, Birmingham, AL 35236

F: (205) 985-8674

Nashville750 Old Hickory Road, Building Two, Ste 150 Brentwood, TN 37027

(615) 794-8961

Would you like more investment choices for your retirement funds?

With an IRA INNOVATIONS self-directed IRA, you are in full control of the investments in your retirement account. You choose what you want to invest in from a wide range of permissible assets.

At IRA INNOVATIONS, our goal is to provide our customers with the most complete and accurate information regarding the full range of investments choices available within your retirement plan.

We specialize in the record keeping and administration of all truly self-directed qualified retirement plans and in educating our clients on the unique investments that are a part of them.

Here are some of the investment options that our current clients have taken advantage of:

l Real Estate – apartments, single family homes, commercial property or undeveloped landl Limited Liability Companiesl Private Limited Partnershipsl Secured and Unsecured Notesl Mortgages/Deeds of Trustl Partnerships and joint venturesl Private stockl Publicly traded stocks, bonds, mutual fundsl Other investmentsl Judgments/Structured Settlementsl Tax Sale Certificatesl Car Paperl Factoringl Accounts Receivablel Commercial Paperl Equipment Leasing

The new tax laws affecting retirement plans can be confusing and complicated. And depending upon your finan-cial situation, your future goals and whether you might have an employee-sponsored plan available, you will need to choose between several alternatives.

Consult with your tax advisor or financial planner on the best course of action. If you decide that a self-direct-ing your retirement investments is for you, IRA INNOVATIONS is here to help.

Call IRA Innovations at (205) 985-0860 and get started on your self-directed IRA today.

We are never in conflict with your investment decisions because we do not endorse or sell any investment products.

www.IRAInnovations.com a P.O. Box 360750, Birmingham, AL 35236 a 205.985.0860 a 205.985.8674 (fax)


What’s included in this packet?

Application form Use this form to open a SIMPLE IRAFee Schedule This document outlines the fees associated with a self-directed IRA.Transfer form Use this form to move your cash directly from your existing IRA to your Innovations

self-directed IRA without taking receipt of the funds. Do not use this form to make a direct rollover.

Rollover form This form is intended to document the roll over of your money and/or asset from your previous 401k to your IRA Innovations account. IRA Innovations does not initiate the roll over. To rollover your money and/or asset, please contact your current IRA holder and indicate that you would like to move your money and/or assets from your existing IRA account to your Innovations IRA . For multiple transac-tions, please use a separate form for each. Use this form to:• Document your rollover contribution to IRA Innovations (take receipt of the assetsfor up to 60 days before reinvesting in a new retirement plan).• Document your direct rollover contribution (move assets directly from your qualifiedretirement plan to a new retirement plan).

IRS form 5305-SEP – Completed byEmployer

The 5305-SEP defines the employee eligibility, contributions and other requirements and provisions for establishing a SEP IRA plan.l Employers must complete the 5305-SEP disclosure contained in this kit. This disclo-sure contains a mandatory application and instructions for employers as well as infor-mation for employees.

Retain the original for your records and forward a copy to IRA Innovations.

Before you fill out the form, you’ll want to make sure you have:

l Your social security numberl Your beneficiary information

If you have a current IRA or 401(k) and you’d like to roll over or transfer funds into your account with IRA Innovations, you’ll also need:

l Your employer addressl Your employer phone numberl Your account number


Application Checklist

Once you’ve completed your application, use this checklist to make sure you have not missed anything:

o Have you included a clear, legible copy of your photo ID (where you can identify the person inthe photo clearly? Please make sure that the copy of the photo ID is clearly readable and legible.

o Have you included your account set up fee, if applicable?

o Have you indicated which fee option you would prefer? Have you signed the fee option page?

o Have you completed the application?

o Have you indicated the type of account that you’d like to open?

o Have you indicated how you would like to fund your account?

o Have you documented your beneficiaries, including their Social Security Numbers?

o If applicable, have you signed your name?

o If you’re married, have you reviewed the beneficiary section of the application?

o If so, has your spouse signed this section?

o Have you signed the application?

Once you’ve completed this form, please send it to:

IRA Innovations P.O. Box 360750,

Birmingham, AL 35236 Fax: (205) 985-0860

Email: [email protected]


Home phone:______________________________ Fax: ______________________ Cell: _______________________

Occupation:______________________________________ Industry:_______________________________________(If retired, please also state former occupation and industry.)

County of Residence: ________________________________ Marital Status: c Single c Married

Email:________________________________________________________________________________________ From what office did you learn about IRA Innovations? c Alabama c Tennessee

2. Account Type Please select one.

c Traditional IRA c Roth IRA c Health Savings Account Type: c Self-only coverage c Family coverage

c SEP IRA (Please attach 5305 SEP form.) Name of Business: ______________________________________________________

c Simple IRA (Please attach 5305 SIMPLE form.) Name of Business: _________________________________________________

c Beneficiary IRA Original IRA Holder Name: __________________________________________________________

Type: c Traditional c Roth c SEP c SIMPLE

3. Application Fee Please note there is a $60 application fee to open an account.

Credit Card Type: c Visa c Mastercard c Discover c American Express c Check (made payable to IRA Innovations LLC)

Credit Card Number: _______________ - _______________ - _______________ - _______________

Expiration Date: _____________ /_____________ Card Identification Number _________________________ (Amex - ID on card front. All others, last three digits on back of card.)

4. How You Heard About Us

c Internet c Radio c TV c Article c Event ____________________________

c Referred by _________________________ c Other ____________________________

Page 1 of 3

Account Application

This is a PDF fillable form. To complete the form, click in an area and type.

1. Personal Information All information is required.

c Mr. c Ms. c Mrs. c Dr. Legal Name ______________________________________________________________

Legal Address (no P. O. Box allowed) _______________________________________________________________________

City, State, Zip __________________________________________________________________________________

Mailing Address (optional) ____________________________________________________________________________

City, State, Zip __________________________________________________________________________________

Date of birth (MM/DD/YYYY) Social Security Number (Required)

For office use only:

Account Number: _________________

/ /


5. Indicate Beneficiaries If designating a Trust as the beneficiary, please include a copy of the Trust Abstract.

I designate the persons named below as the Primary and/or Contingent Beneficiaries of this account. A beneficiary shall be deemed to be a Primary Beneficiary if the Primary or Contingent box is not selected for said beneficiary. In the event of my demise, Primary Beneficiaries who survive me shall receive the assets of the account in equal shares (or in the specified shares, as designated). If all Primary Beneficiaries pre-decease me, Contingent Beneficiaries who survive me shall receive the assets of the account in equal shares (or in the specified shares, as designated). A Primary or Contingent beneficiary’s interest and the interest of such benefi-ciary’s heirs shall terminate completely, in the event that the aforementioned beneficiary does not survive me. In such cases, the share for any remaining Primary or Contingent Beneficiary shall be increased on a pro rata basis. In the event that there are no surviving Primary or Contingent Beneficiaries, remaining assets of the account shall be distributed to my estate in accordance with the plan provisions. This section is to be completed if your legal residence is in a Community Property State and your spouse has not been designated as your Primary Beneficiary with 100% share.I understand that I may change or add beneficiaries at any time by completing and delivering theproper form to the Administrator. Please initial.

c Primary c Contingent

Name: _________________________________________________________SSN: _______________________________________

Address: _______________________________________________________ Relationship: __________________________________

City: ___________________________________________________________State:________________________Zip:___________

Date of Birth:________________________________________________________ Share:___________________________________ %

If I named a Beneficiary which is a Trust, I understand I must supply a copy or abstract of the Trust.


Name: _________________________________________________________SSN: _______________________________________


City: ___________________________________________________________State:________________________Zip:___________




Name: _________________________________________________________SSN: _______________________________________


City: ___________________________________________________________State:________________________Zip:___________




Name: _________________________________________________________SSN: _______________________________________


City: ___________________________________________________________State:________________________Zip:___________



6. Spousal Consent (only required if your spouse is not the primary beneficiary-see note below).

The consent of spouse must be signed only if all of the following conditions are present:

a. Your spouse is living;b. Your spouse is not the sole primary beneficiary named

I am the spouse of the account holder listed above. I hereby certify that I have reviewed the Beneficiary Designation and I understand that I have a property inter-est in the account. I hereby acknowledge and consent to the above Beneficiary Designation other than, or in addition to, myself as primary beneficiary. I further acknowledge that I am waiving part or all of my rights to receive benefits under this plan when my spouse dies.I, ________________________________________________________________________________ hereby consent to the above Beneficiary Designation.

Spouse Signature: _________________________________________________________________ Date: __________________________________

Account Application

Page 2 of 3


Account Application

7. Appointment of Custodian, Investment Direction and Important Disclosures.Your signature is required. Please read before signing. The account holder shown on the front of this application must read this agreement carefully and sign and date this part. By signing this application, you acknowledge the following:

Custodian and Administrator: The Custodian for my account is First Trust Company of Onaga (FTCO) and the Administrator for my account is IRA Innovations, LLC. I understand that the Custodian and the Administrator may resign by giving me written notice at least 30 days prior to the effective date of such resignation. I understand that if I fail to notify the Administrator of the appointment of a successor trustee or custodian within such 30 day period, then the assets held by the Custodian in my account (whether in cash or personal or real property, wherever located, and regardless of value) will be distributed to me, outright and free of trust, and I will be wholly responsible for the tax consequences of such distribution.

No Tax, Legal or Investment Advice: I acknowledge that the Custodian and the Administra-tor do not provide or assume responsibility for any tax, legal or investment advice with respect to the investments and assets in my account, and will not be liable for any loss which results from my exercise of control over my account. I understand that my account is self-directed, and I take com-plete responsibility for any investments I choose for my account. I further understand that neither the Custodian nor the Administrator sells or endorses any investment products. If the services of the Custodian and the Administrator were marketed, suggested or otherwise recommended by any person or entity, such as a financial representative or investment promoter, I understand that such persons are not in any way agents, employees, representatives, affiliates, partners, independent contractors, consultants, or subsidiaries of the Custodian or the Administrator, and that the Custo-dian and Administrator are not responsible for and are not bound by any statements, representa-tions, warranties or agreements made by any such person or entity. I agree to consult with my own CPA, attorney, financial planner, or other professional prior to directing the Administrator to make any investment in my account.

Prohibited Transactions: I understand that my account is subject to the provisions of Internal Revenue Code (IRC) Section 4975, which defines certain prohibited transactions. I acknowledge and agree that neither the Custodian nor the Administrator will make any determination as to whether any transaction or investment in my account is prohibited under sections 4975, 408(e) or 408A, or under any other state or federal law. I accept full responsibility to ensure that none of the investments in my account will constitute a prohibited transaction and that the investments in my account comply with all applicable federal and state laws, regulations and requirements.

Unrelated Business Income Tax: I understand that my account is subject to the provisions of IRC Sections 511-514 relating to Unrelated Business Taxable Income (UBTI) of tax-exempt organizations. I agree that if I direct the Administrator to make an investment in my account which generates UBTI, I will be responsible for preparing or having prepared the required IRS Form 990-T tax return, an application for an Employer Identification Number (EIN) for my account, and any other documents that may be required, and to submit them to the Administrator for filing with the Internal Revenue Service at least ten (10) days prior to the date on which the return is due, along with an appropriate directive authorizing the Administrator to execute the forms on behalf of my account and to pay the applicable tax from the assets in my account. I understand that the Custodian and the Administrator do not make any determination of whether or not investments in my account generate UBTI; have no duty to and do not monitor whether or not my account has incurred UBTI; and do not prepare Form 990-T on behalf of my account.

Valuations: I understand that the assets in my account are required to be valued annually at the end of each calendar year in accordance with IRC Section 408(i) and other guidance provided by the IRS, and that the total value of my account will be reported to the IRS on Form 5498 each year. I agree to provide the year end value of any illiquid and/or non-publicly traded investments, which may include without limitation limited partnerships, limited liability companies, privately held stock, real estate investment trusts, hedge funds, real estate, secured and unsecured promissory notes, and any other investments as the Custodian shall designate, by no later than January 10th of each year, with substantiation attached to support the value provided. I agree to indemnify and hold harmless the Custodian and the Administrator from any and all losses, expenses, settlements, or claims with regard to investment decisions, distribution values, tax reporting or any other financial impact or consequence relating to or arising from the valuation of assets in my account.

Indemnification: I agree that the Custodian and the Administrator have no duty other than to follow my written instructions, and will be under no duty to question my instructions and will not be liable for any investment losses sustained by me or my account under any circumstances.

I understand that the Custodian and the Administrator are acting only as my agent, and nothing will be construed as conferring fiduciary status on the Custodian or the Administrator. I agree to indemnify and hold harmless the Custodian and the Administrator from any and all claims, damages, liability, actions, costs, expenses (including reasonable attorneys’ fees) and any loss to my account as a result of any action taken (or omitted to be taken) pursuant to and/or in connection with any investment transaction directed by me or my investment advisor or resulting from serv-ing as the Custodian or the Administrator, including, without limitation, claims, damages, liability, actions and losses asserted by me.

Electronic Communications, Signatures, and Records: I acknowledge and agree that my account will be subject to the provisions of the Uniform Electronic Transactions Act, as passed in the state where the Custodian is organized (Kansas Statutes Annotated (KSA) Sections 16-601 et seq.), and the federal Electronic Signature in Global and National Commerce Act (ESIGN Act, as contained in 15 U.S.C. 7001), as those laws pertain to electronic communication, electronic signatures, and electronic storage of Custodial Account records. I understand that, in lieu of the retention of the original records, the Administrator and Custodian may cause any, or all, of their records, and records at any time in their custody, to be photographed or otherwise reproduced to permanent form, and any such photograph or reproduction shall have the same force and effect as the original thereof and may be admitted in evidence equally with the original.

Responsibility for determining eligibility and tax consequences: I assume complete responsibility for 1) determining that I am eligible to make a contribution to my account; 2) ensuring that all contributions I make are within the limits set forth by the relevant sections of the Internal Rev-enue Code; and 3) the tax consequences of any contribution (including a rollover contribution) and distributions.

No FDIC Insurance for Investments: I recognize that investments purchased and/or held within my account: 1) are not insured by the Federal Deposit Insurance Corporation (FDIC); 2) are not a deposit or other obligation of, or guaranteed by, either the Custodian or the Administrator; and 3) are subject to investment risks, including possible loss of the principal amount invested.

Our Privacy Policy: You have chosen to do business with the Custodian and the Administrator. As our client, the privacy of your personal non-public information is very important. We value our customer relationships and we want you to understand the protections we provide in regard to your accounts with us.

Information We May Collect: We collect non-public personal information about you from the following sources to conduct business with you:• Information we receive from you on applications or other forms;• Information about your transactions with us, or others;

Non-public personal information is non-public information about you that we may obtain in con-nection with providing financial products or services to you. This could include information you give us from account applications, account balances, and account history.

Information We May Share: We do not sell or disclose any non-public information about you to anyone, except as permitted by law or as specifically authorized by you. We do not share non-public personal information with our affiliates or other providers without prior approval by you. Federal law allows us to share information with providers that process and service your accounts. All providers of services in connection with the Custodian and Administrator have agreed to the Custodian’s and the Administrator’s confidentiality and security policies. If you decide to close your account or become an inactive customer, we will adhere to the privacy policies and practices as described in this notice.

Confidentiality and Security: We restrict access to non-public personal information to those employees who need to know that information to provide products and services to you. We maintain physical, electronic, and procedural guidelines that comply with federal standards to guard your non-public personal information. The Custodian and the Administrator reserve the right to revise this notice and will notify you of any changes in advance.

If you have any questions regarding this policy, please contact us at the address and or telephone number listed on this Adoption Agreement.

Under penalties of perjury, I certify that the above information (including my Social Security number) is correct. I hereby agree to participate in the Individual Retirement Custodial Account offered by the Custodian. I acknowledge receipt of a copy of the plan document under which this Individual Retirement Account is established, a copy of this Adoption Agreement, and a copy of this Disclosure Statement with respect to the Individual Retirement Account. I direct that all benefits upon my death be paid as indicated above. In the event that this is a rollover contribution, I hereby irrevocably elect, pursuant to the requirements of Section 1.402(a)(5)-1T of the IRS regulations, to treat this contribution as a rollover contribution. If I named a beneficiary which is a trust, i understand I must provide certain information concerning such trust to the Custodian.

Account Holder’s Signature: _______________________________________________

Date: _______________________________________________________________

For office use only: Custodian or Authorized Representative Signature_________________________________

Date: _______________________________________________________________Page 3 of 3


Page 1 of 1

Fee ScheduleTraditional IRA, Roth IRA, SEP, SIMPLE, Coverdell ESA,

HSA and Qualified PlanThis is a PDF fillable form. To complete the form, click in an area and type.

1. Annual Asset Holding Fees are due when your IRA purchases an asset and annually on the anniversary month of the asset purchase:

Annual Asset Holding Fee – Please choose ONE option:

c Option One: Fee Based on Number of Investments: $295 Per Asset and/or Liability

c Option Two: Fee Based on Total Account ValueTotal Account Value: Annual Asset Fee:

$0 $14,999.99 $195

$15,000 $29,999.99 $260

$30,000 $44,999.99 $325

$45,000 $59,999.99 $390

$60,000 $89,999.99 $450

$90,000 $124,999.99 $525

$125,000 $249,999.99 $650

$250,000 $499,999.99 $775

$500,000 $749,999.99 $1,500

$750,000 and up $1,850

$60

$95

$125

$30 each

$10 each

$5

$30

$30

$150/hour

$100 plus normal transaction charges

$150

2. Transaction Fees

Account set up fee: Fee is due when application paperwork is submitted & includes a copy of The Self Directed IRA Handbook.

Purchase, Sale, Exchange or Re-Registration of any non-Real Estate Asset/Liability:

Purchase, Sale, Exchange or Re-Registration of any Real Estate Asset/Liability:

Outgoing wires:

Cashiers or other official bank check:

Trust checks

Overnight mail:

Returned Items or Stop Payment Request:

Special services, such as research on any account (including closed accounts), expedited services or additional processing

required for certain complex transactions: Rush fee for services requested within 24 hours

Account Termination

3. Pay fees by: Please note there is a $60 application fee to open an account.c IRA Account c Visa c Mastercard c Discover c American Express c Check (made payable to IRA Innovations)

Credit Card Number: ___________________ - ___________________ - ___________________ - ___________________

Expiration Date:______________ /_________________ Card Identification Number (CVC): _________________________

Billing Method: Always charge my credit card Only charge my credit card if no funds are available in my retirement

Annual asset holding fees are normally withdrawn from your undirected funds within 20 days after the invoice date. In accordance with your plan and trust disclosure which you received as part of your application, Custodial fees are part of the plan and trust disclosure. In accordance with your Account Application, this Fee Disclosure is part of your Agreement with the Administrator and must accompany your Application. If a signed Fee Disclosure is not received with your Application, fees will be based on “Option 2—Account Value”. Custodians Fees. I agree that Mainstar Trust (MST), Custodian shall be entitled to receive from the assets held in my account, a fee equal in amount to all income that is generated from any undirected cash (defined as any cash in my account not invested pursuant to a specific investment direction by me) which has been deposited by the Custodian into FDIC or other United States government insured financial institutions, United States government securities, or securities that are insured or guaranteed by the United States government as provided by the Plan Agreement and Disclosure. I agree that this fee may be retained by MST as compensation for the services provided by MST in relation to my account. MST may pay all or an agreed portion of this fee to IRA Innovations Inc. as agreed between MST and IRA Innovations, LLC. I acknowledge and agree that MST may hold any Undirected Cash in a deposit or product of any FDIC insured financial institution or in United States government securities or in securities that are insured or guaranteed by the United States government without any further approval or direction by me. I agree that IRA Innovations, LLC. may change its fee schedule at any time by giving me 30 days prior written notice. If payment is not received within 20 days from the date reflected on the invoice, a past due notice will be mailed to me and a late fee equal to the lower of (a) 1.5% of the outstanding invoice for every month or partial month that the invoice is outstanding or (b) the maximum late penalty permitted under the state law of Alabama. Additionally, IRA Innovations, LLC may liquidate assets from the account , without notice, for any outstanding fee which has not been paid. If fees are not paid within thirty (30) days after IRA Innovations, LLC has mailed a past due notice, IRA Innovations, LLC will begin the process of closing the account. I understand that any asset distributed directly to me as part of closing my account will be reported to the IRS on Form 1099 and may subject me to possible taxes and penalties. I agree that accounts with past due fees, underfunded accounts, and accounts with zero value will continue to incur administration fees until such time as I notify IRA Innovations, LLC of my intent to close the account or until IRA Innovations, LLC and/or Custodian resigns.

Printed Name _______________________________________________________________________________________________________________

Signature ___________________________________________________________________ Date ____________________________________


Date:

ORAccount will be

closed if not funded within 60 days.

Accounts with no credit card on file are required to maintain minimum undirected cash balance as prepayment of fees in the amount of $500.


Page 1 of 2

Transfer FormThis is a PDF fillable form. To complete the form, click in an area and type.

Use this form to move assets directly from one custodian to your IRA Innovations self-directed IRA without taking receipt of the funds. Do not use this form to make a direct rollover. If you wish to liquidate any assets as part of your transfer to IRA Innovations, ensure that the liquidation process is completed PRIOR to completing this form. Transfer of your funds may be delayed if this step is not taken. The terms and conditions of this docu-ment are incorporated into the Account holder’s account application (the “Account Application”), and the terms and conditions of the Account Application are incorporated herein. Please return this form to IRA Innovations, the Administrator of your plan.

1. Personal Information

Legal Name: _____________________________________________________ Account #:_____________________________

Legal Address (Required) __________________________________________________________________________________

City, State, Zip _________________________________________________________________________________________

Home phone:____________________________________ Fax: ________________________ Cell: ______________________ Date of birth (MM/DD/YYYY) Social Security Number (Required)

2. Resigning Custodian/Trustee (Where your funds are currently. Express deliveries cannot be delivered to a PO Box)

Please include a recent statement from the resigning custodian account.Name of Custodian/Trustee ____________________________________________Account number________________________

Office address _________________________________________________________________________________________

City, State, Zip _________________________________________________________________________________________

Phone number: ________________________ Fax#: _____________________ Contact name: __________________________

3. Type of account to be transferred/eligibility (Must transfer to the same type of account at IRA Innovations.)

I am transferring FROM the following type of plan: (Check one.) HSA

HSA

c Traditional c Roth c Beneficiary IRA c SEP c SIMPLE c ESAI am transferring TO the following type of plan: (Check one.)c Traditional c Roth c Beneficiary IRA c SEP c SIMPLE c ESAI am an eligible person to perform this transaction: (Check one.)c Account owner c Responsible Individual (ESA) c Death Beneficiary

4. Type of asset to be transferred (Indicate whether this is A. COMPLETE Transfer OR B. PARTIAL Transfer.)

Please indicate what you would like to transfer by indicating CASH and/or IN-KIND. If you need to liquidate investments, please contact your resigning Custodian to ensure the liquidation process is completed PRIOR to submitting this form. Please select one below.

Option 1: COMPLETE TRANSFERc Cash - Send cash to “IRA Innovations as agent for Custodian FBO [your name] IRA # _____________________________c In Kind. Additional transaction documents are required to facilitate this transfer. Please reference the Incoming In-Kind Transfer Checklist and

complete next section on form.

Option 2: PARTIAL TRANSFER c Cash - Send cash to “IRA Innovations as agent for Custodian FBO [your name] IRA # _____________________________c In Kind. Additional transaction documents are required to facilitate this transfer. Please reference the Incoming In-Kind Transfer Checklist and

complete next section on form.

*Please allow five business days for checks and one business day for wires to clear.


Date:

/ / - -


Page 2 of 2

5. Description of assets to be transferred: Please attach additional delivery instructions if needed. Fees may apply from your resigning custodian.

Asset description (For cash balances, please indicate amount.) Amount

6. Delivery Instructions:a. How would you like us to send this transfer request to your current resigning Custodian?

Via c Mail c Express delivery ($30 fee) - Cannot express to a PO Box - Please select how you would like to pay the fee:c Check (Made payable to IRA Innovations) c Credit card on filec Credit Card authorization form attached

b. How would you like your cash sent from your resigning Custodian to IRA Innovations? Via c Mail/Check c Wire/Electronic (Please note fees may apply from your resigning custodian)

Please allow five business days to clear. Please allow one business day to clear.

7. Signature and Acknowledgement (This does not constitute a direct rollover.)

• I understand the rules and conditions applicable to the Account Transfer set forth herein.• I qualify for the account transfer of assets listed in the Asset Description above and authorize such transfer.• I understand that no person affiliated with Administrator has any authority to agree to anything different than as set forth herein.• I hereby agree to the terms and conditions set forth in this Transfer Form and my Account Application.

______________________________________________________________Account Holder Signature

______________________________________________________________Date

For office use onlyACCEPTANCE OF RECEIVING CUSTODIANPursuant to a limited written delegation, First Trust Company of Onaga, as Custodian (“Custodian”), has authorized IRA Innovations, LLC to sign this form on Custodian’s behalf to verify Custodian’s acceptance of the transfer described above and in agreement to apply the proceeds upon receipt to the Account established by IRA Innovations, LLC on the account holders behalf. Custodian ASSUMES NO TRUST OR FIDUCIARY OBLIGATIONS TO ACCOUNT HOLDER AS IT HAS NO INVESTMENT CONTROL OVER ACCOUNT HOLDER’S FUNDS AND ACTS ONLY AS A CUSTODIAN OF ACCOUNT HOLDER’S FUNDS. IRA Innovations, LLC on behalf of Custodian, First Trust Company of Onaga.

By:_______________________________________________________________________________________________________________________

Date:_____________________________________________________________________________________________________________________

Account #: _________________________________________________________________________________________________________________

Type of Account:

Traditional

(Medallion Guarantee Stamp)

Transfer FormThis is a PDF fillable form. To complete the form, click in an area and type.

PRIOR TO SIGNING, PLEASE CONSULT YOURRESIGNING CUSTODIAN TO DETERMINE IF A

MEDALLION GUARANTEE STAMP IS REQUIRED

Roth Beneficiary IRA SEP SIMPLE ESA HSA

Fax


1. Personal Information All information is required.

Legal Name_______________________________________ IRA Innovations Account Type and # ____________________

Legal Address (no P. O. Box allowed) ____________________________________________________________________

City, State, Zip _____________________________________________________________________________________

Date of birth (MM/DD/YYYY) Social Security Number (Required)

Home phone:_______________________________ Fax: _____________________________ Cell: _______________________

2. Name of Resigning Custodian/Sponsor

Company Name______________________________________ Account # _____________________________________

Legal Address (no P. O. Box allowed) ____________________________________________________________________

City, State, Zip _____________________________________________________________________________________

Contact Name: ___________________________________________ Contact phone: _____________________________

3. Type of Plan You Are Rolling Over Fromc Traditional c ROTH c SEP c SIMPLE c HSA c 401K c Other ___________

4. Verify that you are eligible to perform this transaction - select one.I am an eligible person to perform this transaction: (Select one): c Plan participant c Spouse beneficiary of account c Non-spouse beneficiary of account c Ex-Spouse of account due to divorce/legal separation c Responsible individual5. Rollover InstructionsTo Rollover CASH:Rollover Amount: $____________________________________

By CHECK - Make check payable to IRA INNOVATIONS, LLC as agent for Cusodian FBO __________________ [your name] IRA # ______________________________. Please allow five business days for checks clear.

By WIRE - Please contact our office for wiring instructions Please allow one business day for wires to clear.

To Rollover IN-KIND ASSETS:Please complete the section below and contact our office regarding the re-registration of your asset.Asset Description: _____________________________________________Amount: ______________________________Asset Description: _____________________________________________Amount: ______________________________6. Signature Please print this form first, then sign and mail the document to your IRA Innovations office. Please note: Your resigning Custodian may require additional documentation. Please read the following statement carefully

IRA Innovations, L.L.C. (“Administrator”) performs record keeping and administration duties in connection with Account holder’s self-directed retirement account (the “Ac-count”) on behalf of the custodian (“Custodian”) as set forth in Account holder’s account application (the “Account Application”). The terms and conditions of this document are incorporated into the Account Application, and the terms and conditions of the Account Application are incorporated herein. I hereby agree to the terms and conditions set forth in this Rollover Certification and acknowledge having established an Account through execution of the Account Application. I understand the rules and conditions applicable to a (check one) c Rollover c Direct Rollover. I qualify for the Rollover or Direct Rollover of assets listed in the Asset Liquidation above and authorize such transactions. If this is a Rollover or Direct Rollover, I have been advised to see a tax advisor due to the important tax consequences of rolling assets into a self-directed account. If this is a Rollover or Direct Rollover, I assume full responsibility for this Rollover or Direct Rollover transaction and will not hold Administrator or Custodian of either the distributing or receiving plan liable for any adverse consequences that may result. I understand that no one at Administrator or any of its licensees or franchisees has authority to agree to anything different as set forth herein. If this is a Rollover or Direct Rollover, I irrevocably designate this contribution of assets with a value of $ ______________ as a rollover contribution. By sign-ing this form, I certify that I am completing this rollover within 60 calendar days following the day I received the assets. I have not performed a rollover from an IRA within the last 12 months and the rollover DOES NOT contain my Required Minimum Distribution. If I am a non-spouse beneficiary, this is a direct rollover from an employer plan and the rollover contribution DOES NOT contain my Required Minimum Distribution.

Account holder’s Signature: _________________________________________________________ Date: ___________________________ Page 1 of 1

Rollover Certification Form

This is a PDF fillable form. To complete the form, click in an area and type.


Date:

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2I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING

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INSTRUCTIONS TO PRINTERSFORM 5305-SEP, PAGE 1 OF 2MARGINS; TOP 13mm (1/2"), CENTER SIDES. PRINTS: HEAD TO HEADPAPER: WHITE WRITING, SUB. 20. INK: BLACKFLAT SIZE: 216mm (8-1/2") x 279mm (11")PERFORATE: None

OMB No. 1545-0499Simplified Employee Pension—IndividualRetirement Accounts Contribution Agreement

Form 5305-SEP(Rev. December 2004) Do not file

with the InternalRevenue Service

Department of the TreasuryInternal Revenue Service (Under section 408(k) of the Internal Revenue Code)

makes the following agreement under section 408(k) of theInternal Revenue Code and the instructions to this form.(Name of employer)

The employer agrees to provide discretionary contributions in each calendar year to the individual retirement account or individualretirement annuity (IRA) of all employees who are at least years old (not to exceed 21 years old) and have performedservices for the employer in at least years (not to exceed 3 years) of the immediately preceding 5 years. This simplifiedemployee pension (SEP) includes does not include employees covered under a collective bargaining agreement,

includes does not include certain nonresident aliens, and includes does not include employees whose totalcompensation during the year is less than $450*.

The employer agrees that contributions made on behalf of each eligible employee will be:A. Based only on the first $205,000* of compensation.B. The same percentage of compensation for every employee.C. Limited annually to the smaller of $41,000* or 25% of compensation.D. Paid to the employee’s IRA trustee, custodian, or insurance company (for an annuity contract).

Name and titleEmployer’s signature and date

Section references are to the InternalRevenue Code unless otherwise noted.

When not to use Form 5305-SEP. Do notuse this form if you:

1. Currently maintain any other qualifiedretirement plan. This does not prevent youfrom maintaining another SEP.

Contribution limits. You may make anannual contribution of up to 25% of theemployee’s compensation or $41,000*,whichever is less. Compensation, for thispurpose, does not include employercontributions to the SEP or the employee’scompensation in excess of $205,000*. If youalso maintain a salary reduction SEP,contributions to the two SEPs together maynot exceed the smaller of $41,000* or 25% ofcompensation for any employee.

2. Have any eligible employees for whomIRAs have not been established.

3. Use the services of leased employees(described in section 414(n)).

4. Are a member of an affiliated servicegroup (described in section 414(m)), acontrolled group of corporations (described insection 414(b)), or trades or businesses undercommon control (described in sections 414(c)and 414(o)), unless all eligible employees ofall the members of such groups, trades, orbusinesses participate in the SEP.

Purpose of Form

Eligible employees. All eligible employeesmust be allowed to participate in the SEP. Aneligible employee is any employee who: (1) isat least 21 years old, and (2) has performed“service” for you in at least 3 of theimmediately preceding 5 years. You canestablish less restrictive eligibilityrequirements, but not more restrictive ones.

Simplified employee pension. A SEP is awritten arrangement (a plan) that provides youwith an easy way to make contributionstoward your employees’ retirement income.Under a SEP, you can contribute to anemployee’s traditional individual retirementaccount or annuity (traditional IRA). You makecontributions directly to an IRA set up by orfor each employee with a bank, insurancecompany, or other qualified financialinstitution. When using Form 5305-SEP toestablish a SEP, the IRA must be a Modeltraditional IRA established on an IRS form ora master or prototype traditional IRA forwhich the IRS has issued a favorable opinionletter. You may not make SEP contributionsto a Roth IRA or a SIMPLE IRA. Making theagreement on Form 5305-SEP does notestablish an employer IRA described insection 408(c).

* For 2005 and later years, this amount is subject to annual cost-of-living adjustments. The IRS announces the increase, if any, in a news release, in the Internal RevenueBulletin, and on the IRS website at www.irs.gov.

Cat. No. 11825J Form 5305-SEP (Rev. 12-2004)

Article I—Eligibility Requirements (check applicable boxes—see instructions)

Article II—SEP Requirements (see instructions)

Instructions

Instructions to the Employer

Service is any work performed for you forany period of time, however short. If you area member of an affiliated service group, acontrolled group of corporations, or trades orbusinesses under common control, serviceincludes any work performed for any periodof time for any other member of such group,trades, or businesses.

Excludable employees. The followingemployees do not have to be covered by the

Form 5305-SEP (Model SEP) is used by anemployer to make an agreement to providebenefits to all eligible employees under asimplified employee pension (SEP) describedin section 408(k).

5. Will not pay the cost of the SEPcontributions. Do not use Form 5305-SEP fora SEP that provides for elective employeecontributions even if the contributions aremade under a salary reduction agreement.Use Form 5305A-SEP, or a nonmodel SEP.Note. SEPs permitting elective deferralscannot be established after 1996.

If this SEP is intended to meet thetop-heavy minimum contribution rules ofsection 416, but it does not cover all youremployees who participate in your salaryreduction SEP, then you must make minimumcontributions to IRAs established on behalf ofthose employees.

Deducting contributions. You may deductcontributions to a SEP subject to the limits ofsection 404(h). This SEP is maintained on acalendar year basis and contributions to the

Contributions cannot discriminate in favor ofhighly compensated employees. Also, you maynot integrate your SEP contributions with, oroffset them by, contributions made under theFederal Insurance Contributions Act (FICA).

You are not required to make contributionsevery year, but when you do, you mustcontribute to the SEP-IRAs of all eligibleemployees who actually performed servicesduring the year of the contribution. Thisincludes eligible employees who die or quitworking before the contribution is made.

For more information on SEPs and IRAs,see Pub. 560, Retirement Plans for SmallBusiness (SEP, SIMPLE, and Qualified Plans),and Pub. 590, Individual RetirementArrangements (IRAs).

Do not file Form 5305-SEP with the IRS.Instead, keep it with your records.

For Paperwork Reduction Act Notice, see page 2.

SEP: (1) employees covered by a collectivebargaining agreement whose retirementbenefits were bargained for in good faith byyou and their union, (2) nonresident alienemployees who did not earn U.S. sourceincome from you, and (3) employees whoreceived less than $450* in compensationduring the year.

2I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

INSTRUCTIONS TO PRINTERSFORM 5305-SEP, PAGE 2 OF 2MARGINS; TOP 13mm (1/2"), CENTER SIDES. PRINTS: HEAD TO HEADPAPER: WHITE WRITING, SUB. 20. INK: BLACKFLAT SIZE: 216mm (8-1/2") x 279mm (11")PERFORATE: None

Page 2Form 5305-SEP (Rev. 12-2004)

Tax treatment of contributions. Employercontributions to your SEP-IRA are excludedfrom your income unless there arecontributions in excess of the applicable limit.Employer contributions within these limits willnot be included on your Form W-2.

Completing the agreement. This agreementis considered adopted when:

Employee contributions. You may makeregular IRA contributions to an IRA. However,the amount you can deduct may be reducedor eliminated because, as a participant in aSEP, you are covered by an employerretirement plan.

Information for the EmployeeThe information below explains what a SEP is,how contributions are made, and how to treatyour employer’s contributions for taxpurposes. For more information, see Pub. 590.

SEP participation. If your employer does notrequire you to participate in a SEP as acondition of employment, and you elect not toparticipate, all other employees of youremployer may be prohibited from participating.If one or more eligible employees do notparticipate and the employer tries to establisha SEP for the remaining employees, it couldcause adverse tax consequences for theparticipating employees.

1. The law that relates to your IRA.2. The tax consequences of various options

concerning your IRA.3. Participation eligibility rules, and rules on

the deductibility of retirement savings.

Simplified employee pension. A SEP is awritten arrangement (a plan) that allows anemployer to make contributions toward yourretirement. Contributions are made to atraditional individual retirementaccount/annuity (traditional IRA).Contributions must be made to either aModel traditional IRA executed on an IRSform or a master or prototype traditional IRAfor which the IRS has issued a favorableopinion letter.

4. Situations and procedures for revokingyour IRA, including the name, address, andtelephone number of the person designatedto receive notice of revocation. Thisinformation must be clearly displayed at thebeginning of the disclosure statement.

Your employer will provide you with a copy ofthe agreement containing participation rules anda description of how employer contributionsmay be made to your IRA. Your employer mustalso provide you with a copy of the completedForm 5305-SEP and a yearly statement showingany contributions to your IRA.

SEP-IRA amounts—rollover or transfer toanother IRA. You can withdraw or receivefunds from your SEP-IRA if, within 60 days ofreceipt, you place those funds in the same oranother IRA. This is called a “rollover” andcan be done without penalty only once in any1-year period. However, there are norestrictions on the number of times you maymake “transfers” if you arrange to have thesefunds transferred between the trustees or thecustodians so that you never havepossession of the funds.

5. A discussion of the penalties that maybe assessed because of prohibited activitiesconcerning your IRA.

All amounts contributed to your IRA by youremployer belong to you even after you stopworking for that employer.

6. Financial disclosure that provides thefollowing information:

a. Projects value growth rates of your IRAunder various contribution and retirementschedules, or describes the method ofdetermining annual earnings and charges thatmay be assessed.

An employer is not required to make SEPcontributions. If a contribution is made,however, it must be allocated to all eligibleemployees according to the SEP agreement.The Model SEP (Form 5305-SEP) specifiesthat the contribution for each eligibleemployee will be the same percentage ofcompensation (excluding compensationgreater than $205,000*) for all employees.

b. Describes whether, and for when, thegrowth projections are guaranteed, or astatement of the earnings rate and the termson which the projections are based.

Withdrawals. You may withdraw youremployer’s contribution at any time, but anyamount withdrawn is includible in yourincome unless rolled over. Also, if withdrawals

c. States the sales commission for eachyear expressed as a percentage of $1,000.

Contribution limits. Your employer willdetermine the amount to be contributed toyour IRA each year. However, the amount forany year is limited to the smaller of $41,000*or 25% of your compensation for that year.Compensation does not include any amountthat is contributed by your employer to yourIRA under the SEP. Your employer is notrequired to make contributions every year orto maintain a particular level of contributions.

An employer may not adopt this IRS ModelSEP if the employer maintains anotherqualified retirement plan. This does notprevent your employer from adopting this IRSModel SEP and also maintaining an IRSModel Salary Reduction SEP or other SEP.However, if you work for several employers,you may be covered by a SEP of oneemployer and a different SEP or pension orprofit-sharing plan of another employer.

● IRAs have been established for all youreligible employees;

● You have completed all blanks on theagreement form without modification; and

● You have given all your eligible employeesthe following information:

Employers who have established a SEPusing Form 5305-SEP and have furnishedeach eligible employee with a copy of thecompleted Form 5305-SEP and provided theother documents and disclosures described inInstructions to the Employer and Informationfor the Employee, are not required to file theannual information returns, Forms 5500 or5500-EZ for the SEP. However, under Title I ofthe Employee Retirement Income Security Actof 1974 (ERISA), this relief from the annualreporting requirements may not be available toan employer who selects, recommends, orinfluences its employees to choose IRAs intowhich contributions will be made under theSEP, if those IRAs are subject to provisionsthat impose any limits on a participant’s abilityto withdraw funds (other than restrictionsimposed by the Code that apply to all IRAs).For additional information on Title Irequirements, see the Department of Laborregulation at 29 CFR 2520.104-48.

In addition, the financial institution mustprovide you with a financial statement eachyear. You may want to keep these statementsto evaluate your IRA’s investment performance.

Excess SEP contributions. Contributionsexceeding the yearly limitations may bewithdrawn without penalty by the due date(plus extensions) for filing your tax return(normally April 15), but are includible in yourgross income. Excess contributions left inyour SEP-IRA after that time may haveadverse tax consequences. Withdrawals ofthose contributions may be taxed aspremature withdrawals.

1. A copy of Form 5305-SEP.

2. A statement that traditional IRAs otherthan the traditional IRAs into which employerSEP contributions will be made may providedifferent rates of return and different termsconcerning, among other things, transfers andwithdrawals of funds from the IRAs.

3. A statement that, in addition to theinformation provided to an employee at thetime the employee becomes eligible toparticipate, the administrator of the SEP mustfurnish each participant within 30 days of theeffective date of any amendment to the SEP,a copy of the amendment and a writtenexplanation of its effects.

4. A statement that the administrator willgive written notification to each participant ofany employer contributions made under theSEP to that participant’s IRA by the later ofJanuary 31 of the year following the year forwhich a contribution is made or 30 days afterthe contribution is made.

Financial institution requirements. Thefinancial institution where your IRA ismaintained must provide you with a disclosurestatement that contains the followinginformation in plain, nontechnical language:

SEP are deductible for your tax year with orwithin which the calendar year ends.Contributions made for a particular tax yearmust be made by the due date of yourincome tax return (including extensions) forthat tax year.

Paperwork Reduction Act Notice. You arenot required to provide the informationrequested on a form that is subject to thePaperwork Reduction Act unless the formdisplays a valid OMB control number. Booksor records relating to a form or its instructionsmust be retained as long as their contentsmay become material in the administration ofany Internal Revenue law. Generally, taxreturns and return information are confidential,as required by section 6103.

Recordkeeping 1 hr., 40 min.

If you have comments concerning theaccuracy of these time estimates or suggestionsfor making this form simpler, we would behappy to hear from you. You can write to theInternal Revenue Service, Tax ProductsCoordinating Committee, SE:W:CAR:MP:T:T:SP,1111 Constitution Ave. NW, Washington, DC20224. Do not send this form to this address.Instead, keep it with your records.

Learning about thelaw or the form 1 hr., 35 min.Preparing the form 1 hr., 41 min.

The time needed to complete this form willvary depending on individual circumstances.The estimated average time is:

occur before you reach age 591⁄2, you may besubject to a tax on early withdrawal.

Documents

Self-Directed IRA Application Packet€¦ · Self-Directed IRA Application Packet SEP Application Packet Office 100 Concourse Parkway P Suite 170 Birmingham, AL 35236 Birmingham,